Analysis Of String-overalls-suture Pancreaticojejunostomy In Preventing Of Postoperative Pancreatic Fistula

Objective:In this study,the preoperative routine data,intraoperative observations,operative time and postoperative complications between the"string-overalls-suture"pancreaticojejunostomy and the"pancreatic duct jejunal mucosa"pancreaticojejunostomy were compared to explore the advantages of"string-overalls-suture"pancreaticojejunostomy in the prevention of postoperative pancreatic fistula and the risk factors of postoperative pancreatic fistula.And related research and analysis were made.Methods:Clinical data of 70 cases receiving pancreaticoduodenectomy in the Affiliated Zhongshan Hospital of Dalian University from January 2011 to December 2018 were retrospectively studied.All cases were divided into Experimental group and Control group according to the different ways of pancreaticojejunostomy.Patients in Experimental group received"string-overalls-suture"pancreaticojejunostomy,and those in Control group received"pancreatic duct jejunal mucosa"pancreaticojejunostomy.The other preoperative preparations,surgical procedures and routine postoperative procedures were the same.The 70 cases were performed by the same team.The differences of preoperative routine data(age,gender,body mass index,hypertension,diabetes,hepatitis B,abdominal surgery,preoperative biliary drainage,totalbilirubin,albumin,serumamylase,hemoglobin),intraoperative observation(pancreatic texture,pancreatic duct diameter,intraoperative blood loss),operative time and postoperative complication rate(postoperative pancreatic fistula,postoperative bleeding,postoperative intra-abdominal infection,delayed postoperative gastric emptying)between the two groups were compared and analyzed.The risk factors of postoperative pancreatic fistula were explored by univariate and multivariate analysis.Result:1.70 operations were successfully completed.There was no statistical differences between the two groups in general data and intraoperative observations.2.The total operative time was 4.28±1.10 hours in Control group and 3.62±0.76hours in Experimental group.It was significantly different between the two groups(t=2.942,p=0.004).3.There were 7(28.0%)cases occurred with postoperative pancreatic fistula including 6 cases of grade B,and 1 case of grade C in Control group,and 3(6.7%) cases which all were grade B in Experimental group.It was significantly different for postoperative pancreatic fistula between the two groups(χ~2=4.358,P=0.037).There were 6(24.0%)cases occurred with postoperative bleeding in Control group,7(15.6%)cases in Experimental group.It was no significant differences for postoperative bleeding between two groups(χ~2=0.302,P=0.582).And 8(32.0%) cases occurred with abdominal infection in Control group,8(17.8%) cases in Experimental group.It was no significant differences for abdominal infection between two groups(χ~2=1.844,P=0.175).Delayed gastric emptying occurred in 3(12.0%) cases in Control group,4(8.9%) cases in Experimental group.It was no significant differences for delayed gastric emptying between two groups(χ~2=0,P=1).4.The univariate analysis showed that after the traditional"pancreatic duct jejunal mucosa"pancreaticojejunostomy,non-dilatation of the pancreatic duct and intraoperative hemorrhage exceeding 400ml were risk factors for the occurrence of postoperative pancreatic fistula.Multivariate regression analysis showed that non-dilatation of the pancreatic duct was an independent risk factor for postoperative pancreatic fistula.Conclusion:Traditional "pancreatic duct jejunal mucosa" pancreaticojejunostomy,non-dilatation of the pancreatic duct and intraoperative hemorrhage exceeding 400ml were risk factors for the occurrence of postoperative pancreatic fistula.Non-dilatation of the pancreatic duct was an independent risk factor for postoperative pancreatic fistula.Comparingwith"pancreaticductjejunalmucosa"pancreaticojejunostomy,"string-overalls-suture"pancreaticojejunostomy with simple and quick manipulation,wide indication,safe and reliable pancreaticojejunostomy,has certain superiorities in shortening operation times and reducing postoperative pancreatic fistula.It is worth of promotion and application in Pancreaticoduodenectomy.